Outline

Objective

To evaluate the long-term results of transpupillary thermotherapy (TTT) in exudative age-related macular degeneration (AMD) with 24 months follow-up and to confront them with the findings in the fellow untreated eye.

Methods

In a prospective study TTT was performed in 50 patients, 17 men and 37 women aged 50-93 years (mean 70,2 years). At the initial and follow-up examinations every 3 months following investigations were performed: visual acuity (VA), indirect binocular ophthalmoscopy, slit lamp biomicroscopy, fluorescein and mostly also indocyanine green angiography and optical coherence tomography (OCT). In all patients only one eye was treated, the fellow eye served as a control.

Results

In all patients AMD was found in both eyes. The fellow untreated eye suffered from dry non-exudative AMD in 26 patients (52%), and from advanced exudative AMD with disciform scarring in 24 patients (48%). In 3 patients with a dry AMD a reversal into exudative AMD was observed. Final mean VA in dry AMD was 0,72, in advanced exudative AMD 0,04. TTT was performed due to occult choroidal neovascularization (CNV) in 21 eyes (42%), serous pigment epithelial detachment (SPED) in 19 eyes (38%) and classic CNV in 10 eyes (20%). After TTT final VA was improved or stabilised in 20 eyes (40%), and deteriorated in 30 eyes (60%). Mean VA decreased from initial 0,26 to 0,16 at 24 months follow-up. At the last control biomicroscopic exudative changes disappeared in 31 eyes (62%), fluorescein angiography demonstrated absence of leakage in 32 eyes (64%), and OCT confirmed absence of oedema and exudation in 28 eyes (56%). Some chorioretinal atrophy was observed after regression of exudative changes in all eyes, and was associated with subretinal fibrosis till disciform scarring in 27 eyes (54%).

Conclusions

The long-term results of TTT with 24 months follow-up demonstrated regression of macular exudative changes in the most eyes with exudative AMD. TTT did not prevent the development of chorioretinal atrophy and subretinal fibrosis, the chief causes of progressing visual loss. The course of exudative AMD in the fellow eye was always highly unfavourable and its final VA was significantly worse than in the treated eye.